Medical Marijuana: A “Don’t” for Bipolar Disorder

Marijuana is a popular drug-of-choice. Anywhere from 25-45% of bipolar disorder patients have used it at some point. It’s legal in twenty-three states and Washington, D.C. In four of these states (Alaska, Colorado, Oregon & Washington State), it’s legal for recreational use. In the rest, it’s legal for medical treatment only. Cannabis is used to treat numerous maladies, some with resounding success. CNN’s chief medical correspondent, Dr. Sanjay Gupta, even made a documentary when he changed his stance to being in favor of using the drug medicinally. It’s relatively safe, has a low addiction rate, and can be produced at high quality with a low cost to the consumer. So what’s the catch?

According to the United Patient’s Group, cannabis can be recommended for psychiatric illnesses (laws and regulations vary by state). Depressed? Anxious? Bipolar disorder? Schizophrenia? All of these are said to benefit from the use of cannabis. However, a recent study published in the journal Psychiatry Investigation determined that marijuana users were less likely to achieve remission in bipolar disorder. Specifically, the outcome is worse for women when it comes to depression and men when it comes to mania.

Earlier findings have shown that marijuana use can elevate mood in bipolar disorder in the short-term. Basically it can relieve anxiety or depression at first. Marijuana affects cannabinoid receptors in the amygdala, a region of the brain that regulates anxiety. Marijuana is able to decrease anxiety by reducing excitatory signals in the amygdala. So everything calms down and you’re able to find some sort of relief. However, this is only in the short term. Over time, the receptors will wear down and anxiety will actually increase.

Long-term use of the drug has shown several negative effects. First, marijuana can trigger manic symptoms in some patients due to the “elevation” effects I mentioned earlier. It can trigger psychosis, increase rapid cycling and mixed states and also exacerbate depressive episodes. The depression effect is particularly strong in women, who are generally more likely to be diagnosed with depression or bipolar disorder overall. Women also spend more time in depressive episodes of bipolar disorder. So, it can be reasonably assumed that they would be more affected by habitual marijuana use.

Marijuana use can also affect how a patient responds to medication. If it’s combined with mood stabilizers, the outcome is actually worse than with either drug alone. It’s not clear what causes the more negative outcomes. There are no known high-risk drug interactions as far as processing in the liver, so the problem may be brought on due to the effects on neural responses. Also, patients who regularly use marijuana don’t tend to stick to medication schedules as well as those who do not use it. With drugs like mood stabilizers, anti=psychotics and even anti-depressants, it’s important to keep the levels of the medication in your system balanced. This is why you’re supposed to talk to a doctor before changing your dose. Missing a single dose of medication has negative effects. So if your body is only getting some of what it’s used to, combined with another mood-altering drug, it’s no wonder that cannabis users tend to fare worse. That’s just bad chemistry.

So what if you’re a medical marijuana user? Well, first, talk to your doctor if you have any concerns. Second, there’s good news. If you stop using cannabis, there don’t seem to be any lasting effects. Evidence has shown that even quitting during a cycle did not produce any more negative side-effects. Patients recovered to the point where they would have been had they never used marijuana in the first place. So, no, quitting or starting marijuana use will not cure your bipolar disorder, but continuing chronic use will make it worse.